Key result
SENC myocardial strain predicts ~310% greater MACE risk, adding prognostic value beyond conventional CMR markers.
Why the study?
CMR is the gold standard for diagnostic classification and risk stratification in cardiac disorders, but the ability of strain-encoded MR to predict MACE required evaluation.
Does myocardial strain assessed by SENC/fast-SENC predict major adverse cardiovascular events and mortality in patients undergoing cardiac magnetic resonance?
Meta-Analysis (n=1,332)
Yes
Does myocardial strain assessed by SENC/fast-SENC predict major adverse cardiovascular events and mortality in patients undergoing cardiac magnetic resonance?
Effect estimate: HR 4.1 (95% CI 3.0-5.5)
p-value: p=<0.001
Reduced myocardial strain assessed by SENC/fast-SENC provides incremental prognostic value for predicting all-cause mortality and MACE beyond clinical data and conventional CMR markers.
Supports integration of SENC strain into CMR risk stratification; extends evidence of incremental prognostic value beyond conventional markers.
BACKGROUND. Cardiac magnetic resonance (CMR) is the gold standard for the diagnostic classification and risk stratification in most patients with cardiac disorders. PURPOSE/HYPOTHESIS. To investigate the ability of Strain-encoded MR (SENC) for the prediction of major adverse cardiovascular events (MACE). STUDY TYPE Systematic review and meta-analysis according to the PRISMA Guidelines. POPULATION. Patients with or without cardiovascular disease and asymptomatic individuals. FIELD STRENGTH/SEQUENCE Myocardial strain by HARP in 1.5T scanners. ASSESSMENT. Published literature in MEDLINE (PubMed) and Cochrane’s databases were explored before February 2023 for studies assessing the clinical utility of myocardial strain by Harmonic Phase Magnetic Resonance Imaging (HARP), Strain-encoded MR (SENC) or fast-SENC. In total, 8 clinical trials (4 studies conducted in asymptomatic individuals and 4 in patients with suspected or known cardiac disease) were included in this systematic review, while 3 studies were used for our meta-analysis, based on individual patient level data. STATISTICAL TESTS. Kaplan-Meier analysis and Cox proportional hazard models were used, testing the ability of myocardial strain by HARP and SENC/fast-SENC for the prediction of MACE. RESULTS Strain enabled risk stratification in asymptomatic individuals, predicting MACE and the development of incident heart failure. Of 1,332 patients who underwent clinically indicated CMR, including SENC or fast-SENC acquisitions, 19 patients died, 28 experienced non-fatal infarctions, 52 underwent coronary revascularization and 86 were hospitalized due to heart failure during 22.4(17.2-28.5) months of follow-up. SENC/fast-SENC, predicted both all-cause mortality and MACE with high accuracy (HR=3.0, (95%CI=1.2-7.6), p=0.02 and HR=4.1, 95%CI=3.0-5.5, respectively, p<0.001). Using hierarchical cox-proportional hazard regression models, SENC/fast-SENC exhibited incremental value to clinical data and conventional CMR markers. DATA CONCLUSION. Reduced myocardial strain predicts of all-cause mortality and cardiac outcomes in symptomatic patients with a wide range of ischemic or non-ischemic cardiac diseases, whereas in asymptomatic individuals, reduced strain is a precursor of incident heart failure.
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Korosoglou et al. (2023) conducted a meta-analysis in Suspected or known cardiac disease (n=1,332). Strain-encoded MR (SENC/fast-SENC) vs. Conventional CMR markers was evaluated on Major adverse cardiovascular events (MACE) (HR 4.1, 95% CI 3.0-5.5, p=<0.001). Myocardial strain assessed by SENC/fast-SENC predicted major adverse cardiovascular events (HR 4.1) and all-cause mortality, providing incremental prognostic value beyond conventional CMR markers.
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